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Right Ventricular Outflow Tract Reconstruction with a Small Size Conduit in Infancy FREE TO VIEW

Mark Ruzmetov, MD*; John W. Brown, MD; Palasniswamy Vijay, PhD; Mark D. Rodefeld, MD; Mark W. Turrentine, MD
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Indiana University School of Medicine, Zionsville, IN


Chest


Chest. 2004;126(4_MeetingAbstracts):732S-b-733S. doi:10.1378/chest.126.4_MeetingAbstracts.732S-b
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Abstract

PURPOSE:  Right ventricular outflow tract (RVOT) reconstruction with a conduit in infancy creates a physiologically normal biventricular circulation, and unlike shunts, avoids surgery on the branch pulmonary arteries.

METHODS:  From March 1994 to December 2002, 73 infants (mean age 2.7 + 3.1 months, mean weight 7.2 + 2.4 kg) underwent conduit implantation for complex cardiac anomalies. Right ventricle-pulmonary artery continuity was established with an aortic (n=16) or pulmonary (n=41) homograft conduit in 57 patients, a Dacron polyester porcine-valved conduit in 5, a non-valved polytetrafluoroethylene (PTFE) tube in 3, and a bovine jugular venous valved conduit in 8. Mean conduit diameter was 12.2 + 1.9 mm.

RESULTS:  Early mortality was 18% (13/73 pts). Patients with complex anomalies (interrupted aortic arch, severe truncal valve regurgitation, absent pulmonary valve syndrome) were risk factors for early mortality (p=0.005). Mean follow-up time was 42 months. Thirty patients (51%, 30 of 59) underwent 39 reoperations: conduit replacement (n=14) or PTFE transannular monocusp RVOT reconstruction (n=25). Mean time to reoperation was 4.2 + 2.3 years. Mean size of replacement conduit was 19.3 + 2.8 mm. There was one late death after reoperation. The probability of freedom from reoperation at 5 years was 28% after first repair.

CONCLUSION:  Reconstruction of RVOT with a small sized conduit can be performed with low mortality in non-complex anomalies in infancy. Conduits with small size have earlier graft failure and need for reoperation. Repair in patients under one year of age, even when a conduit is necessary, is preferred over palliative alternatives for most anomalies.

CLINICAL IMPLICATIONS:  Right ventricular outflow tract reconstruction with a conduit in infancy creates a physiologically normal biventricular circulation, and unlike shunts, avoids surgery on the branch pulmonary arteries. From March 1994 to December 2002, 73 infants underwent conduit implantation for complex cardiac anomalies. Reconstruction of RVOT with a small sized conduit can be performed with low mortality in non-complex anomalies in infancy. Conduits with small size have earlier graft failure and need for reoperation.

DISCLOSURE:  M. Ruzmetov, None.

Tuesday, October 26, 2004

10:30 AM- 12:00 PM


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